NurseReview.Org - Alteration In Metabolism

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Published on November 13, 2007

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Alteration In Metabolism

Choose life, so that you and your children may live Deuteronomy 30:19

Sherrie-Ann L. Vergara, MD UP College of Medicine Class 2005

Course Requirement: Basic understanding of your Basic Sciences Topics: • GI Tract Pathology • Endocrine Glands Pathology • Others : Low birth weight infants, Vitamins Basis of Grades: • Attendance/ Recitation • Reports • Quizzes • Exams, etc.

TYPES OF METABOLISM 1. Anabolic - simple to complex 2. Catabolic - complex to simple

FUNCTIONS OF LIFE DIGESTION 3. RESPIRATION 4. GROWTH 5. RESPONSIVENESS 6. REPRODUCTION 7. EXCRETION 8. MOVEMENT 9.

WHAT IS METABOLISM? It pertains to all the chemical reactions that occur in a living system necessary for the performance of various functions of life.

Each function involves several chemical  reactions Each chemical reaction involves several  steps Each of the different function is  interrelated Each chemical reactions are interrelated 

OVERVIEW OF DIGESTIVE DISORDERS 1. CLASSIFICATIONS 2. UPPER GIT 3. LOWER GIT 4. ACCESORY ORGANS

CLASSIFICATION DIGESTIVE DISORDERS 1. FUNCTIONAL a. Obstruction b. Absorption c. Hyperactivity 2. ANATOMICAL a. Upper GIT b. Lower GIT

METABOLIC IMPLICATION OF GIT DISORDERS:

MEANS OF MAINTAINING FUNCTION ALTERNATIVE FEEDING PATTERNS a. IV Infusion b. Enteral Hyperalimentation c. Total Parenteral Nutrition d. Elemental Diets e. Fat Emulsion Feeding

UPPER GIT • dysphagia • Vomiting or Regurgitation • Flatulence • Pain • Hematemesis • Melena

LOWER GIT • Pain • Vomiting or Regurgitation • Flatulence • Abdominal Distention • Hematochezia • Diarrhea •Constipation

BW < 2500 grams

Prematurity  Small for Gestational Age (SGA) 

•Genetic or Chromosomal Abnormalities • Acquired Congenital Diseases

• Placental Insufficiency • Cord Coil •Multiple gestation

• Maternal Illness • Reproductive organ anomally • Nutritional Status • Smoking • Alcoholism

PROBLEMS WITH LBW BABIES • Greater risk for respiratory problems • Higher risk for Intraventricular Hemorrhage • Associated cardiac problems with premature babies • Impaired thermoregulation • Slower growth

PREVENTION • Regular prenatal check up • Multivitamins • Avoidance of smoking and alcohol

PREVENTION • Adequate nutrition • Judicious use of medications

Among the most common congenital anomalies  Severity varies  May present as a cleft lip, cleft palate or both  Cause is Multifactorial  - Genetic - Environmental

• Defective growth the medial Failure of fusion of of palatal shelves nasal and maxillary process during the 5th week of embyonic • Failure of the shelves to attain developmentposition a horizontal • Lack of contact between shelves • Rupture after fusion of shelves

MAJOR MEDICAL CONCERN • Risk of aspiration because of communication between oral and nasal cavities • Airway obstruction • Difficulties with feeding of a child with a cleft and nasal regurgitation

Breastfeeding an infant with a cleft • Massaging the breast and applying hot packs on the breast 20 minutes before nursing usually helps. • The mother should apply pressure to the areola with her fingers to help the engorged nipple protrude.. • If the infant cannot hold onto the nipple any more, the mother can collect the remaining milk and can finish the feeding with collected milk in a bottle. • The mother should increase her fluid intake (drink lots of water).

Feeding milk with a bottle • A variety of nipples and bottles are made specifically for infants with clefts. • A soft nipple is generally better than a hard nipple • Use a crosscut nipple to prevent choking. The crosscut is on the tongue side. • The bottle should be squeezed and released, not continually squeezed. • The nipple is angled to a side of the mouth, away from the cleft.

Other recommendations • More upright or seated positions prevent the milk from leaking to the nose and causing the infant to choke. •Advise the mother to stop feeding and allow the infant to cough or sneeze for a few seconds when nasal regurgitation occurs. • Gaining weight and preventing aspiration and ear infections are the most important parts of caring for neonates with a cleft during their first days and weeks of life.

RECOMMENDED PROTOCOL • Diagnostic examination, general counseling of parents, feeding instructions • Age 3 months - Repair of CL and placement of ventilation tubes • Age 6 months - Presurgical orthodontics, if necessary; first speech evaluation • Age 9 months - Speech therapy begins

RECOMMENDED PROTOCOL • Age 9-12 months - Repair of CP (placement of ventilation tubes if not done at the time of CL repair) • Age 1-7 years - Orthodontic treatment • Age 7-8 years - Alveolar bone graft • Older than 8 years - Orthodontic treatment continues

The most common cause of intestinal  obstruction in infancy Also known as infantile hypertrophic  pyloric stenosis (IHPS) Etiology is unknown and probably  Multifactorial

GIT GENETICS DEVELOPMENT ENVIRONMENTAL HYPERTROPHY And HYPERPLASIA NARROWING OF THE GASTRIC ANTRUM NONBILIOUS DECREASED EPIGASTRIC VISIBLE IMPAIRED VOMITING URINE AND DISTENTION GASTRIC DEHYDRATION (METABOLIC STOLL (OLIVE-SHAPED NUTRITION PERISTALSIS ALKALOSIS) OUTPUT MASS)

OTHER COMMON FINDINGS: Hypochloremic, hypokalemic metabolic alkalosis  Hypernatremia or hyponatremia  Dilated stomach bubble ON X-ray  String sign and shoulder sign on UGI 

DIAGNOSTICS Plain x-rays  Ultrasonography  Normal UGIS Gastric Outlet Obstruction

DIAGNOSTICS Upper gastrointestinal imaging (UGI)  Electrolytes, pH, BUN, and creatinine 

MANAGEMENT: Immediate treatment requires correction of fluid  loss, electrolytes, and acid-base imbalance Surgery is the curative treatment 

MANAGEMENT: Endoscopic balloon dilatation has been used in  certain selected patients with short-term symptomatic relief

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